Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder

New York State Psychiatric Institute, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 08/2011; 49(8):453-8. DOI: 10.1016/j.brat.2011.04.004
Source: PubMed


Despite elevated rates of obsessive compulsive personality disorder (OCPD) in patients with obsessive compulsive disorder (OCD), no study has specifically examined comorbid OCPD as a predictor of exposure and ritual prevention (EX/RP) outcome. Participants were adult outpatients (n = 49) with primary OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) total score ≥ 16 despite a therapeutic serotonin reuptake inhibitor dose for at least 12 weeks prior to entry. Participants received 17 sessions of EX/RP over 8 weeks. OCD severity was assessed with the YBOCS pre- and post-treatment by independent evaluators. At baseline, 34.7% of the OCD sample met criteria for comorbid DSM-IV OCPD, assessed by structured interview. OCPD was tested as a predictor of outcome both as a diagnostic category and as a dimensional score (severity) based on the total number of OCPD symptoms coded as present and clinically significant at baseline. Both OCPD diagnosis and greater OCPD severity predicted worse EX/RP outcome, controlling for baseline OCD severity, Axis I and II comorbidity, prior treatment, quality of life, and gender. When the individual OCPD criteria were tested separately, only perfectionism predicted worse treatment outcome, over and above the previously mentioned covariates. These findings highlight the importance of assessing OCPD and suggest a need to directly address OCPD-related traits, especially perfectionism, in the context of EX/RP to minimize their interference in outcome.

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    • "Although there are effective treatments for OCD (Olatunji et al., 2013; Rees, 2009), the literature indicates that there are certain diagnostic profiles that can further add to the challenge of client engagement. A co-morbid diagnosis of obsessive-compulsive personality disorder has been shown to complicate the treatment of OCD (Pinto, Liebowitz, Foa, & Simpson, 2011). Clients with these disorders have difficulty presenting for treatment, revealing the details of their anxiety, staying in treatment, and completing exposure tasks outside of therapy (McNamee, O'Sullivan, Lelliott, & Marks, 1989). "
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    • "reported a poorer response to both pharmacological and behavioural treatment for OCD in the presence of OCPD (Cavedini et al., 1997; Pinto et al., 2011), others did not find OCPD to be a predictor of poorer response to treatment of OCD (Baer et al., 1992; Fricke et al., 2006). "
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    ABSTRACT: Objectives: There are ongoing uncertainties in the relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). This study aimed to test the proposition that OCPD may be a marker of severity of OCD by comparing groups of OCD individuals with and without OCPD on a number of variables. Method: A total of 148 adults with a principal diagnosis of OCD were administered the Mini International Neuropsychiatric Interview, Yale-Brown Obsessive-Compulsive Scale, Sheehan Disability Scale, Vancouver Obsessional Compulsive Inventory and Symptom Checklist 90-Revised. Participants with a DSM-IV diagnosis of OCPD were compared with those without OCPD. Results: Some 70 (47.3%) participants were diagnosed with OCPD. The groups of participants with and without OCPD did not differ significantly with respect to any of the demographic variables, clinician-rated severity of OCD, levels of disability and mean age of onset of OCD. All self-rated OCD symptom dimensions except for contamination and checking were significantly more prominent in participants with OCPD, as were all self-rated dimensions of psychopathology. Participants with OCPD had significantly more frequent hoarding compulsions and obsessions involving a need to collect and keep objects. Of Axis I disorders, only panic disorder was significantly more frequent in participants with OCPD than in those without OCPD. Conclusions: A high frequency of OCPD among individuals with OCD suggests a strong, although not necessarily a unique, relationship between the two conditions. This finding may also be a consequence of the blurring of the boundary between OCD and OCPD by postulating that hoarding and hoarding-like behaviours characterise both disorders. Results of this study do not support the notion that OCD with OCPD is a marker of clinician-rated severity of OCD. However, individuals with OCPD had more prominent OCD symptoms, they were more distressed and exhibited various other psychopathological phenomena more intensely, which is likely to complicate their treatment.
    Full-text · Article · Jun 2012 · Australian and New Zealand Journal of Psychiatry
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    • "Pinto, Liebowitz, Foa and Simpson (2011) found in a sample of individuals with OCD that having a diagnosis of OCPD was a predictor of poorer outcome to exposure and response prevention. Pinto et al. (2011), tested each criteria of OCPD separately regarding treatment outcome, and found that perfectionism predicted poorer treatment outcome over and above all other criteria. Research has also examined the link between OCPD and eating disorders. "

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